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Breast MRI Waiver-
(Blue Cross Only)
Laser Vein Ablation -
Acknowledgment of Financial Responsibility
Non-Medicare Patients of Pueblo Radiology
Forget your insurance card?
Lien Form
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Se le olvido su tarjeta de
seguro medico?
Patient Information:
preparation
forms
scheduling
insurance/billing
patient survey
Forms require Adobe Acrobat Reader.
Download Here
. Please print out forms, fill in and bring to your appointment.
© 2008 Pueblo Radiology Medical Group, Inc.
